發(fā)布時(shí)間：2018-03-15 21:42

  本文選題：肌筋膜扳機(jī)點(diǎn)　切入點(diǎn)：肌筋膜疼痛綜合征　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景及目的:肌筋膜扳機(jī)點(diǎn)(MTrPs)是肌筋膜疼痛綜合征(MPS)關(guān)鍵的病因機(jī)制和臨床治療靶點(diǎn),多位于受累骨骼肌的條索或硬結(jié)上。組織病理學(xué)證實(shí),MTrPs由異常收縮的肌小節(jié)構(gòu)成,而肌小節(jié)異常收縮的機(jī)制目前仍不完全清楚。Rho GTP酶及下游激酶ROCK通過Ca2+敏感性機(jī)制在平滑肌收縮的維持中發(fā)揮重要作用。骨骼肌收縮機(jī)制與平滑肌應(yīng)有相似之處。因此推測,Rho GTP酶(Rho.Racl.Cdc42等)及ROCK可能在MTrPs肌小節(jié)持續(xù)性異常收縮中發(fā)揮重要調(diào)節(jié)作用。本研究的目的是觀察Rho、Rac1、Cdc42及ROCK在MTrPs部位及其鄰近肌小節(jié)中的表達(dá)情況。方法:斜方肌中含有MTrPs的MPS患者20例為病例組(M組),不含MTrPs的頸椎手術(shù)病人10例為對照組(C組)。于M組受試者斜方肌的條索上定位MTrPs,SuperCore活檢針穿刺活檢;于C組受試者斜方肌相應(yīng)部位進(jìn)行活檢。HE及Masson染色法觀察MTrPs肌組織形態(tài)學(xué)改變;免疫組化法檢測Rho(A-C)、Racl、Cdc42及ROCK2的表達(dá)。結(jié)果:HE染色:縱切面中,C組肌小節(jié)排列整齊均勻,橫紋間距為1.91(0.19)um。M組肌小節(jié)異常收縮部位(a部位)的橫紋間距為0.71(0.32)um(p0.05 vs.C組);其鄰近的肌小節(jié)拉長部位(b部位)的橫紋間距為2.33(0.31)um(p0.05 vs.C組;p0.01vs.M組a部位)。橫切面中,C組及M組肌纖維的平均直徑分別為 37.37±3.72um 及 82.61±19.48um(p0.01)。Masson染色:C組及M組肌纖維均呈紅染,肌纖維之間有輕微藍(lán)染,但肌纖維上絕無藍(lán)染現(xiàn)象。免疫組化:①Rho及ROCK:C組肌纖維中Rho(A-C)及ROCK2均勻表達(dá),主要位于肌細(xì)胞質(zhì)中。與C組相比,M組肌小節(jié)異常收縮部位(a部位)胞質(zhì)中Rho及ROCK2的表達(dá)量明顯減少(p0.01),但細(xì)胞膜及膜周緣胞質(zhì)區(qū)可見Rho及ROCK2的表達(dá)。與M組a部位相鄰的肌小節(jié)拉長部位(b部位)胞質(zhì)中Rho及ROCK2的表達(dá)量相對增加(p0.05 vs.M組a部位),但與C組相比無統(tǒng)計(jì)學(xué)差異(p0.05vs.C組)。②Rac1:C組肌纖維中Rac1表達(dá)均勻,主要位于胞質(zhì)中。M組a部位胞質(zhì)中Rac1表達(dá)量明顯減少(p0.01 vs.C組),但b部位胞質(zhì)中Racl表達(dá)量明顯增加(p0.01 vs.C組,且p0.01 vs.M組a部位)。③Cdc42:C組肌纖維中Cdc42表達(dá)均勻。M組Cdc42表達(dá)雖不均勻但M組a、b兩部位Cdc42表達(dá)量與C組相比均無統(tǒng)計(jì)學(xué)差異(p均0.05)。結(jié)論:Rho/ROCK及Rac1(而非Cdc42)可能通過Ca2+敏感性機(jī)制參與MTrPs肌小節(jié)異常收縮的調(diào)節(jié),但其具體病理生理機(jī)制仍待進(jìn)一步研究。
[Abstract]:Background and objective: myofascial trigger (MTrPs) is the key etiological mechanism and clinical therapeutic target of myofascial pain syndrome (MPS), mostly located on the involved skeletal muscle cord or sclerosis. Histopathologically confirmed that MTrPs are composed of abnormal contractile muscle segments. However, the mechanism of abnormal contraction in muscle section is still unclear. Rho GTP enzyme and downstream kinase ROCK play an important role in the maintenance of smooth muscle contraction through the mechanism of Ca2 sensitivity. The mechanism of skeletal muscle contraction should be similar to that of smooth muscle. Therefore, we speculated that Rho GTP enzyme Rho.Racl.Cdc42 and ROCK may play an important regulatory role in the sustained abnormal contraction of MTrPs muscle. The purpose of this study was to observe the expression of Rho Rac1CDc42 and ROCK in MTrPs and its adjacent muscles. Methods:. Twenty patients with MPS with MTrPs in trapezius muscle and 10 patients with cervical vertebra operation without MTrPs were selected as control group C, and 20 patients with MPS in trapezius muscle were selected as control group, and the biopsy needle was located on the trapezius muscle of M group. The histomorphological changes of the trapezius muscle in group C were observed by biopsy, HE and Masson staining, and the expression of ROCK2 and CDc42 were detected by immunohistochemical method. Results: in the longitudinal section of group C, the muscle sections of group C were arranged neatly and evenly. The transverse stripe spacing of 1. 91 ~ 0. 19 渭 m. M group was 0. 71 ~ 0. 32 vs.C group (P < 0. 01), and the transverse striation distance was 2. 33 ~ 0. 31 ~ 0. 31 渭 m / m vs.C group p 0. 01 vs.M group (P 0. 01 vs.M group). In the middle of transverse section, the muscle of C group and M group were divided into two groups: group C and group M (P 0. 01 vs.M group), the transverse stripe spacing was 2. 33 ~ 0. 31 ~ 0. 31 vs.C group (p 0. 01 vs.M group). The mean diameters of fibers were 37.37 鹵3.72um and 82.61 鹵19.48um respectively. Masson staining showed red staining in group C and M, respectively. There was slight blue staining in the muscle fibers, but there was no blue staining on the muscle fibers. The positive expression of RHA-C and ROCK2 in the Rho and ROCK:C groups was uniform by immunohistochemistry. Compared with group C, the expression of Rho and ROCK2 in the cytoplasm of group M was significantly decreased, but the expression of Rho and ROCK2 was found in the membrane and peripheral cytoplasm of group M, and the expression of Rho and ROCK2 was observed in part a of group M. The expression of Rho and ROCK2 in the cytoplasm of the adjacent sarcomere elongated area (B) increased relatively, but there was no significant difference between group C and group C in the expression of Rac1 in muscle fiber of group C (p0.05vs.2Rac1: C), and the expression of Rac1 in muscle fiber of group C was uniform, and the expression of Rac1 in muscle fiber of group C was higher than that of group C (P 0.05 vs.C). The expression of Rac1 in cytoplasm of group A was significantly decreased in group A, but the expression of Racl in cytoplasm in group b was significantly increased in group B (P 0.01 vs.C), but the expression of Racl in cytoplasm was significantly increased in group B (P < 0.05). The expression of Cdc42 in group A was uneven, but there was no significant difference in the expression of Cdc42 between group A and group C (P < 0.05). Conclusion the results suggest that the expression of Cdc42 in the muscle fibers of group A and C may be by Ca2 sensitive machine, instead of Cdc42, and the expression of Cdc42 in group A and C is similar to that in group C (P < 0.01), but there is no significant difference in the expression of Cdc42 between group A and group C (P > 0.05). To participate in the regulation of abnormal contraction of MTrPs muscle. However, its pathophysiological mechanism still needs further study.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R686

【參考文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 郭亞秋;EphrinB2在肌筋膜扳機(jī)點(diǎn)的作用機(jī)制研究[D];山東大學(xué);2015年

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本文編號(hào)：1616916